1114941036 NPI number — BERNARD MICHAEL NAGEL JR. MD

Table of content: BERNARD MICHAEL NAGEL JR. MD (NPI 1114941036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114941036 NPI number — BERNARD MICHAEL NAGEL JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAGEL
Provider First Name:
BERNARD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAGEL
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114941036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 TER HEUN DR
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02540-2533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-457-0088
Provider Business Mailing Address Fax Number:
508-540-9613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 TER HEUN DR
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
FALMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02540-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-457-0088
Provider Business Practice Location Address Fax Number:
508-540-9613
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  265335 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)